Leukemic blasts are present at low levels in spinal fluid in one-third of childhood acute lymphoblastic leukemia cases

Background: Central nervous system (CNS) involvement is associated with relapse in childhood acute lymphoblastic leukemia (ALL) and is a diagnostic challenge. Procedure: In a Nordic/Baltic prospective study, we assessed centralized flow cytometry (FCM) of locally fixed cerebrospinal fluid (CSF) samples versus local conventional cytospin-based cytology (CC) for detecting leukemic cells and evaluating kinetics of elimination of leukemic cells in CSF. Results: Among 300 patients with newly diagnosed ALL, 87 (29%) had CSF involvement by FCM, while CC was positive in 30 (10%) of 299 patients with available CC data (P < 0.001). Patients with FCM+/CC+ had higher CSF leukemic blast counts compared to patients positive by FCM only (medians: 0.10 vs. 0.017 leukemic blasts/μl, P = 0.006). Patients positive by FCM had higher white blood cell counts in peripheral blood than patients negative by FCM (medians: 45 × 109/l vs. 10 × 109/l, P < 0.001), were younger (medians: 3 years vs. 4 years, P = 0.03), and more frequently had T-cell ALL (18/87 vs. 16/213, P = 0.001). At treatment day 15, five of 52 patients (10%) who had CSF positive by FCM at diagnosis remained so despite at least two doses of weekly intrathecal chemotherapy. Conclusions: Longer follow-up is needed to clarify whether FCM positivity has prognostic significance and is an indicator for intensified CNS-directed therapy.

Marquart, Hanne V.Copenhagen University Hospital (författare)
Groth-Pedersen, LineCopenhagen University Hospital (författare)
Abrahamsson, JonasSahlgrenska University Hospital (författare)
Albertsen, Birgitte K.Aarhus University Hospital (författare)
Andersen, Mette K.Aarhus University Hospital (författare)
Frandsen, Thomas L.Copenhagen University Hospital (författare)
Harila-Saari, ArjaKarolinska Institutet,Karolinska University Hospital (författare)
Pronk, CornelisLund University,Lunds universitet,Avdelningen för molekylär hematologi,Institutionen för laboratoriemedicin,Medicinska fakulteten,Hematopoetisk och immunologisk utveckling,Forskargrupper vid Lunds universitet,Division of Molecular Hematology (DMH),Department of Laboratory Medicine,Faculty of Medicine,Hematopoietic and immunologic developement,Lund University Research Groups,Skåne University Hospital(Swepub:lu)stem-kpr (författare)
Ulvmoen, AinaOslo university hospital (författare)
Vaitkevičienė, GodaVilnius University Hospital (författare)
Lähteenmäki, Päivi M.Turku University Hospital (författare)
Niinimäki, RiittaOulu University Hospital (författare)
Taskinen, MerviTurku University Hospital (författare)
Jeppesen, MariaCopenhagen University Hospital (författare)
Schmiegelow, KjeldCopenhagen University Hospital (författare)
Copenhagen University HospitalSahlgrenska University Hospital (creator_code:org_t)

Av författaren/redakt...: Levinsen, Mette; Marquart, Hanne ...; Groth-Pedersen, ...; Abrahamsson, Jon ...; Albertsen, Birgi ...; Andersen, Mette ...; visa fler...; Frandsen, Thomas ...; Harila-Saari, Ar ...; Pronk, Cornelis; Ulvmoen, Aina; Vaitkevičienė, G ...; Lähteenmäki, Päi ...; Niinimäki, Riitt ...; Taskinen, Mervi; Jeppesen, Maria; Schmiegelow, Kje ...; visa färre...

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